'There's a much larger plan here' for next phase of Healthy Nevada Project

RENO, Nev. — The largest population health study ever undertaken in the state is already yielding fruit for researchers and residents of Nevada.

The Healthy Nevada Project, which kicked off in Northern Nevada in September 2016 and expanded to Southern Nevada in May of this year, has seen more than 45,000 Nevadans provide no-cost genetic samples to help researchers at the Desert Research Institute gather crucial data for translational private-sector research.

A primary goal of the project, says Joe Grzymski, DRI faculty member and principal investigator, is to create an entity and institution of research that improves health and health research through the state.

Grzymski, who also is chief science officer for Renown Health, says the project could prove as transformative for Nevada as the landmark Framingham Heart Study that reshaped the small, middle-class community west of downtown Boston.

The Healthy Nevada Project was spurred in part by Nevada's consistent low national healthcare rankings for public health funding, federal research funding and mental health services, Grzymski says.

According to the Agency for Healthcare Research and Quality, Nevada ranks in the bottom 10 of all 50 states across all healthcare access measures.

“You name it, and Nevada in health unfortunately is at the bottom,” Grzymski says.

‘Such incredible interest'

The seeds of the Healthy Nevada Project were sown about five years ago when the State Legislature put together a Knowledge Fund administered through the Governor's Office of Economic Development, which was spearheaded by former GOED Executive Director Steve Hill.

Grzymski was one of the leads at DRI who determined how those funds should be utilized and subsequently became the principal investigator for DRI's contributions to the Healthy Nevada Project.

With his extensive background in genetics and genomics — he founded Evozym Biologics and EMS Genomics — Grzymski was quite comfortable with big data research. He teamed with Renown Health's chief executive officer, Anthony Slonim, to enact a study utilizing data available through Renown in order to meet one of the hospital's premier strategic objectives: improving population health.

Population health address the overall problems of a population — which is no mean feat given the challenges of the managing the largest healthcare system located between Sacramento and Salt Lake City.

Within that massive geographical area lie countless rural communities, as well as the entire population of the Truckee Meadows. Key factors of population health include common behavioral health issues, such as addiction, depression and anxiety, as well as health problems such as obesity, heart disease and cancer.

DRI started working with Renown's data and was focused on tying together health determinates data to help predict outcomes of that extensive population, Grzymski says. Health determinates include factors such as individual behavior, history, education and socio-economic considerations — the many intangibles that make up the equation of predicting health outcomes.

However, genetics was a crucial piece missing from the puzzle of aggregating health determinates data. So a pilot study was launched in September 2016 with 23andMe to bring personal genetic information into the larger population health study.

Although the pilot program originally was intended for 5,000 Northern Nevada residents, more than 10,000 residents voluntarily submitted their personal genetic information for the study.

“There was such incredible interest,” Grzymski says. “Given the successes, we subsequently increased the focus on clinical genetics so Renown could integrate those results into its care delivery model.”

Growing to Southern Nevada

Phase 2 of the Healthy Nevada program kicked off in March of 2018 with a new partner, Helix, a renowned population genomics company headquartered at San Carlos, Calif.

The program expanded to Southern Nevada in May 2019 with an alliance through University Medical Center of Southern Nevada to recruit and deliver results in the southern part of the state. Current funding approval is for up to 250,000 Nevadans to participate in the study.

Switching to Helix allowed researchers to access additional regions of the human genome that were unavailable through 23andMe's testing processes. These additional regions are associated with greater risks for disease — and it's this additional layer of testing that could potentially save lives of residents of the Silver State.

Researchers are returning data to residents regarding their risks of contracting three of the major inherited diseases:

• Hereditary breast and ovarian cancer syndrome.
• Familial hypercholesterolemia. This genetic disorder leads to a buildup of LDL cholesterol in the blood and is not related to diet or exercise. FH can lead to a 50-percent increased risk of heart disease.
• Lynch Syndrome. This inherited disorder results in significantly increased risk for colorectal cancer and endometrial cancer in women.

“All three conditions are inherited, and if you know about them early enough you can actually lower your risk of developing the disease,” Grzymski says. “This is a very progressive approach to risk identification and really is one of the hallmarks of the study. We are returning results back to individuals, and those results will save lives.

“We are providing tools back to the individuals so they can take the information and make changes,” he adds. “We know not all people will do that, but when individuals are empowered, there is a better chance for behavioral improvement or going to your doctor and engaging in a better care plan.”

What's next?

Moving forward, Grzymski expects the study to expand across the state, as well as introduce new genetic testing for people who've already participated in the study.

The Healthy Nevada Project is proving to be an impetus that brings additional health research funding into the state.

“Prior to the Healthy Nevada Project, the Desert Research Institute did not have any significant (National Institutes of Health) funding,” Grzymski says. “But because of the work we have been doing we received one of their most prestigious grants. Imagine the trickle-down effect as we grow in size and have the leverage to perform larger and larger research studies — big studies like this tend to attract better doctors and pharma companies that want to make investment near progressive centers of care.

"There's a much larger plan here; we are trying to build something a lot bigger for Nevada.”